Identify the appropriate validated screening instrument (e.g., PRAPARE, AHC-HRSN, Hunger Vital Sign) and locate the corresponding FHIR Questionnaire resource from the Gravity SDOH Clinical Care IG
Administer the screening and map responses to Observation resources conforming to the SDOH Observation screening response profile, setting category to sdoh and using the LOINC panel and item codes for the instrument
Set Observation.status to final, Observation.subject to the Patient reference, and Observation.derivedFrom to the QuestionnaireResponse if one was completed
For positive screening items (indicating a social need), create child Observation resources for each positive finding, setting valueCodeableConcept or valueBoolean to represent the response
Group the individual item Observations under a panel Observation using Observation.hasMember references to create the complete screening response structure
Known gotchas
Gravity SDOH Observation profiles require the sdoh category code from the SDOH Clinical Care category code system — using a generic survey or social-history category without the sdoh code will fail profile validation
The LOINC codes for screening panel items are instrument-specific and version-sensitive; ensure you are using the correct LOINC code for the specific version of the screening tool being administered
A positive screening result (indicating a social risk) should generate a follow-on SDOH Condition — the Observation alone is not sufficient to represent an assessed social need for care coordination purposes
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp